Manzoni Paolo, Decembrino Lidia, Gallo Elena, Rizzollo Stefano, Franco Caterina, Mostert Michael, Stronati Mauro, Farina Daniele
Recenti Prog Med. 2010 Dec;101(12):483-9.
An episode of sepsis occurs in 20 to 40% of all preterm patients, and such figures have been reported constantly increasing in Neonatal Intensive Care Units. Neonatal sepsis include bloodstream, urine, cerebrospinal, peritoneal infections, infections starting from burns and wounds, or from any other usually sterile sites. Many specific risk factors account for the increased risk of sepsis, including employment of broad-spectrum antibiotics selecting resistant microflora, parenteral nutrition, acid inhibitors and steroids, as well as the systematic and long-lasting use of invasive management. In preterm neonates, loss of gut commensals such as bifidobacteria and lactobacilli, due to the difficulties in oral feeding, or a slower acquisition of them, translates into an increased susceptibility to pathogenic gut colonization. Prompt diagnosis, effective treatment, and specific prophylaxis with antibacterial and antifungal drugs are the milestones of management of these life-threatening events. This article discusses the recent advances in prevention and shows how fluconazole for prevention of fungal sepsis, probiotics for prevention of necrotizing enterocolitis, and bovine lactoferrin for prevention of bacterial sepsis may be considered as effective preventive strategies.
20%至40%的早产患者会发生败血症，且在新生儿重症监护病房中，此类数据一直呈上升趋势。新生儿败血症包括血流感染、尿路感染、脑脊液感染、腹膜感染、烧伤和伤口感染，或任何其他通常无菌部位的感染。许多特定风险因素导致败血症风险增加，包括使用广谱抗生素导致耐药菌群产生、肠外营养、酸抑制剂和类固醇，以及长期系统性地使用侵入性治疗手段。在早产儿中，由于经口喂养困难或双歧杆菌和乳酸杆菌等肠道共生菌获得较慢，导致其肠道内此类细菌数量减少，进而增加了其肠道被致病性细菌定植的易感性。及时诊断、有效治疗以及使用抗菌和抗真菌药物进行特异性预防是应对这些危及生命事件的管理关键。本文讨论了预防方面的最新进展，并展示了氟康唑预防真菌败血症、益生菌预防坏死性小肠结肠炎以及牛乳铁蛋白预防细菌性败血症如何可被视为有效的预防策略。
